Cholecystectomy-Associated Postprandial Hypoglycemia

Weiwei Zhao; Jasmine Kaur; Lubna Mirza

doi:10.1016/j.aed.2025.10.004

Cholecystectomy-Associated Postprandial Hypoglycemia

AACE Endocrinol Diabetes. 2025 Oct 10;13(1):71-73. doi: 10.1016/j.aed.2025.10.004. eCollection 2026 Jan-Feb.

Authors

Weiwei Zhao¹, Jasmine Kaur², Lubna Mirza¹

Affiliations

¹ Endocrine/ParaThyroid Center, Norman Regional Health System, Norman, Oklahoma.
² Department of Medicine, Gian Sagar Medical College and Hospital, Rajpura, Punjab, India.

Abstract

Objective: Hypoglycemia is a challenging clinical condition with a broad differential diagnosis, particularly in patients without diabetes. Identifying the underlying etiology is crucial, as management strategies vary significantly.

Case report: We report a case of severe postprandial hypoglycemia in a 19-year-old woman that developed shortly after an uncomplicated cholecystectomy. Extensive evaluation ruled out insulinoma, autoimmune hypoglycemia, and factitious causes.

Discussion: The temporal relationship with surgery, postprandial symptom pattern, and unremarkable imaging suggested bile acid-mediated metabolic dysregulation due to altered bile enterohepatic circulation. The patient responded well to dietary modification and acarbose therapy.

Conclusion: This case highlights the need to consider cholecystectomy in the differential diagnosis of postprandial hypoglycemia, especially when classic etiologies are excluded.

Keywords: bile acid–mediated metabolic dysregulation; cholecystectomy; hypoglycemia.

Publication types

Case Reports